nach oben

Erschienen in:

01.03.2011 | Materno-Fetal Medicine

Successful pregnancy after cyclophosphamide therapy for lupus nephritis

verfasst von: Gabriela Lannes, Fernanda R. Elias, Bernardo Cunha, Nilson Jesus, Evandro M. Klumb, Elisa M. N. Albuquerque, Francinne M. Ribeiro

Erschienen in: Archives of Gynecology and Obstetrics | Sonderheft 1/2011

Einloggen, um Zugang zu erhalten

Abstract

Background

Systemic lupus erythematosus (SLE) often requires administration of cyclophosphamide (CYC), especially for severe glomerulonephritis. As this disease usually affects young women in reproductive age, pregnancy, though not recommended may occur. The teratogenic effects of this drug make pregnancy prognosis and fetal survival indeterminate.

Methods

We reviewed retrospectively the medical records of five patients with SLE who received inadvertently CYC during pregnancy and analyzed fetal outcome.

Results

All patients were exposed at the first trimester. Two patients suffered miscarriages, two went to full term and one presented premature labor.

Conclusion

In spite of potential successful pregnancies after CYC exposure, this drug has teratogenic effects and prescription must be avoided during the pregnancy period. At the same time, the occurrence of these reported unplanned pregnancies strengthen the need of improving patients’ education on pregnancy risks during immunosuppressive treatment.

Greenberg LH, Tanaka KR (1964) Congenital anomalies probably induced by cyclophosphamide. JAMA 188:423–426PubMed

Murray CL, Reichert JA, Anderson J, Twiggs LB (1984) Multimodal cancer therapy for breast cancer in the first trimester of pregnancy. A case report. JAMA 252:2607–2608PubMedCrossRef

Zemlickis D, Lishner M, Erlich R, Koren G (1993) Teratogenicity and carcinogenicity in a twin exposed in utero to cyclophosphamide. Teratog Carcinog Mutagen 13:139–143PubMedCrossRef

Zemlickis D, Lishner M, Degendorfer P, Panzarella T, Sutcliffe SB, Koren G (1992) Fetal outcome after in utero exposure to cancer chemotherapy. Arch Intern Med 152:573–576PubMedCrossRef

Enns GM, Roeder E, Chan RT, Ali-Khan Catts Z, Cox VA, Golabi M (1999) Apparent cyclophosphamide (cytoxan) embryopathy: a distinct phenotype? Am J Med Genet 86:237–241PubMedCrossRef

Hochberg M (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725–1743PubMedCrossRef

Weening JJ, D’Agati VD, Schwartz MM et al (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 15:241–250PubMedCrossRef

Miyakis S, Lockshin MD, Atsumi T et al (2006) International consensus statement on an update of the classification for definite antiphospholipid syndrome (APS). J Thromb Haemost 4:295–306PubMedCrossRef

Pekar O, Molotski N, Savion S, Fein A, Toder V, Torchinsky A (2007) p53 regulates cyclophosphamide teratogenesis by controlling caspases 3, 8, 9 activation and NF-κB DNA binding. Reproduction 134:379–388PubMedCrossRef

10.

Petri M (2003) Immunosuppressive drug use in pregnancy. Autoimmunity 36:51–56PubMedCrossRef

11.

Hayslett JP, Lynn RI (1980) Effect of pregnancy in patients with lupus nephropathy. Kidney Int 18:207–220PubMedCrossRef

12.

Jungers P, Dougados M, Pélissier C, Kuttenn F, Tron F, Lesavre P, Bach FJ (1982) Lupus nephropathy and pregnancy. Report of 104 cases in 36 patients. Arch Intern Med 142:771–776PubMedCrossRef

13.

Julkunen H, Kaaja R, Palosuo T, Gronhagen-Riska C, Taramo K (1993) Pregnancy in lupus nephropathy. Acta Obstet Gynecol Scand 72:258–263PubMedCrossRef

14.

Ramsey-Goldman R, Mientus JM, Kutzer JE, Mulvihill JJ, Medsger TA Jr (1993) Pregnancy outcome in women with systemic lupus erythematosus treated with immunosuppressive drugs. J Rheumatol 20:1152–1157PubMed

15.

Roubenoff R, Hoyt J, Petri M, Hochberg MC, Hellman DB (1988) Effects of anti-inflammatory and immunosuppressive drugs on pregnancy and fertility. Semin Arthritis Rheum 18:88–110PubMedCrossRef

16.

Kart-Köseoglu H, Yücel AE, Künefeci G, Ozdemir FN, Duran H (2001) Cyclophosphamide therapy in a serious case of lupus nephritis during pregnancy. Lupus 10:818–820PubMedCrossRef

17.

Krane NK, Thakur V, Wood H, Meleg-Smiyh S (1995) Evaluation of lupus nephritis during pregnancy by renal biopsy. Am J Nephrol 15:186–191PubMedCrossRef

18.

Østensen M, Ramsey-Goldman R (1998) Treatment of inflammatory rheumatic disorders in pregnancy: what are the safest treatment options? Drug Saf 19:389–410PubMedCrossRef

19.

Paskulin GA, Gazzola Zen PR, de Camargo Pinto LL, Rosa R, Graziadio C (2005) Combined chemotherapy and teratogenicity. Birth Defects Res A Clin Mol Teratol 73:634–637PubMedCrossRef

20.

Gilchrist DM, Friedman JM (1989) Teratogenesis and iv. Cyclophosphamide. J Rheumatol 16:1008–1009PubMed

21.

Clowse MEB, Magder L, Petri M (2005) Cyclophosphamide for lupus during pregnancy. Lupus 14:593–597PubMedCrossRef

22.

Lockshin MD, Sammaritano LR, Schwartzman S (2004) Lupus Pregnancy. In: Lahita R (ed) Systemic lupus erythematosus, 4th edn. Elsevier, San Diego, CA, pp 659–696CrossRef

23.

Matsukawa Y, Nishinarita S, Horie T, Hayama T (1998) Successful child bearing during intravenous cyclophosphamide therapy in a patient with systemic lupus erythematosus. Br J Rheumatol 37:342–343PubMedCrossRef

24.

Park M-C, Park Y-B, Jung SY, Chung IH, Choi KH, Lee S-K (2004) Risk of ovarian failure and pregnancy outcome in patients with lupus nephritis treated with intravenous cyclophosphamide. Lupus 13:569–574PubMedCrossRef

25.

Martínez-Rueda JO, Arce-Salinas CA, Kraus A, Alcocer-Varela J, Alarcón-Segovia D (1996) Factors associated with fetal losses in severe systemic lupus erythematosus. Lupus 5:113–119PubMedCrossRef

Titel: Successful pregnancy after cyclophosphamide therapy for lupus nephritis
verfasst von: Gabriela Lannes
Fernanda R. Elias
Bernardo Cunha
Nilson Jesus
Evandro M. Klumb
Elisa M. N. Albuquerque
Francinne M. Ribeiro
Publikationsdatum: 01.03.2011
Verlag: Springer-Verlag
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe Sonderheft 1/2011
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-011-1859-0

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Successful pregnancy after cyclophosphamide therapy for lupus nephritis